1396230595 NPI number — SHERLEY DORLEANS ARNP/FNP

Table of content: SHERLEY DORLEANS ARNP/FNP (NPI 1396230595)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396230595 NPI number — SHERLEY DORLEANS ARNP/FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DORLEANS
Provider First Name:
SHERLEY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP/FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396230595
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
838 NW 183RD ST STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI GARDENS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33169-4203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-760-2289
Provider Business Mailing Address Fax Number:
305-952-3905

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9931 MIRAMAR PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIRAMAR
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33025-2397
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-251-1130
Provider Business Practice Location Address Fax Number:
305-952-3905
Provider Enumeration Date:
06/29/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  ARNP9281651 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 103283000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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